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Thread: Disease and pandemics thread (because it's science)

  1. #2761
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    Quote Originally Posted by grant hutchison View Post
    I assume that you intended to write "vaccinated and unvaccinate", above. If I were prone to denunciation I'd denounce the bolded statement as an "uninformed, irresponsible, misleading falsehood". But I'm not, so I'll just point out that you're wrong, because the viral load of the infected individual is not the only consideration. We also need to consider the prevalance of disease--how often you will encounter an infected individual, if you mix exclusively with either vaccinated or unvaccinated people.
    An infected individual is less likely to infect a vaccinated than an unvaccinated person. Controlling for other influences, that leads us to understand that we are more likely to be infected by a random unvaccinated person than by a random vaccinated person....( parsed)...

    Grant Hutchison
    Grant, if you have to stoop to typos, you're obviously grasping at straws. You have roughly, eleventeen typos on this discussion. I felt no need to point them out.

    As to your ridiculous point, let's ask the 14 vaccinated adults who attended a party of 14 vaccinated adults and 11 walked out with, The Covid. I am beginning to think, you are a, "Science Denier". Like most, science deniers, you pick what to believe.

    https://www.baltimoresun.com/opinion...whi-story.html

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    Quote Originally Posted by Ely View Post
    Grant, if you have to stoop to typos, you're obviously grasping at straws.
    I mentioned the typo only because I was quoting and referring to that very specific part of your text. I can't very well critique a text without saying what I assume it's intended to mean, if it says something different from what I'm assuming and responding to. For all I know, you might have wanted to write something different from what I assumed--I've more than once responded to someone on the assumption that they'd produced a typo, only to find I'd completely misunderstood their intention, and there was either a different typo, or no typo at all.
    I'm well aware of my own typo rate, BTW, which has risen in recent years for reasons that need not detain us, and I appreciate it when people draw attention to the fact I've written something that I didn't mean, if it's going to lead to potential miscommunication. Maybe that's just me.

    Quote Originally Posted by Ely View Post
    As to your ridiculous point, let's ask the 14 vaccinated adults who attended a party of 14 vaccinated adults and 11 walked out with, The Covid. I am beginning to think, you are a, "Science Denier". Like most, science deniers, you pick what to believe.

    https://www.baltimoresun.com/opinion...whi-story.html
    My "ridiculous point" is a fundamental aspect of disease transmission, which deserves to be better understood. The science of epidemiology is complicated, but endlessly fascinating.
    And your anecdote is irrelevant to the fact that a random unvaccinated individual is more likely to have Covid than a random vaccinated individual, other things being equal.

    Grant Hutchison
    Last edited by grant hutchison; 2021-Aug-22 at 06:49 PM.
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  3. #2763
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    Tidying up:
    The Office for National Statistics Covid-19 Infection Survey publishes its results here. The study I cited earlier is currently at the top of the list. Because the UK has had Delta for a while, and because the ONS is carrying out large random infection surveys, it's a good place to look for recent and reliable information about the Delta variant.
    Information on the behaviour of vaccinated and unvaccinated Americans here, from the Kaiser Family Foundation. (My understanding is that they're considered politically non-partisan, but please correct me by PM if I'm wrong.)

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  4. #2764
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    Great article. I wish we could discuss it further.
    Cum catapultae proscriptae erunt tum soli proscript catapultas habebunt.

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    There have been "breakthrough" cases where people who have been vaccinated became infected with Covid (with symptoms). AFAIK, reports have been anecdotal and hopefully such cases have been rare.

    My question is, have there been cases where people who had been infected with Covid and recovered, but then became infected with Covid again (with symptoms)? In other words, does contracting and recovering from Covid confer "absolute" immunity?
    Everyone is entitled to his own opinion, but not his own facts.

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    Quote Originally Posted by Cougar View Post
    There have been "breakthrough" cases where people who have been vaccinated became infected with Covid (with symptoms). AFAIK, reports have been anecdotal and hopefully such cases have been rare.

    My question is, have there been cases where people who had been infected with Covid and recovered, but then became infected with Covid again (with symptoms)? In other words, does contracting and recovering from Covid confer "absolute" immunity?
    My understanding is that yes, there have been cases of people getting symptomatic COVID twice.
    As above, so below

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    A possibly important issue not raised is whether vaccinated individuals who are unlucky to get a breakthrough infection can also suffer from other long-COVID19 symptoms as equal to not vaccinated people. The initial reports as far as the main symptoms is that breakthroughs are not as severe for the vaccinated. Is there data regarding the long-COVID symptoms for breakthrough cases?

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    Quote Originally Posted by Cougar View Post
    My question is, have there been cases where people who had been infected with Covid and recovered, but then became infected with Covid again (with symptoms)? In other words, does contracting and recovering from Covid confer "absolute" immunity?
    No absolute immunity. People do get symptomatically reinfected, but their infection rate is lower than for "immune naive" people at similar risk. The best data come from health-care workers at the end of last year, before the vaccine roll out. The study here found an 83% lower risk of infection among those who had had a previous Covid infection.
    The immunity is of a slightly different quality after a Covid infection, compared to the mRNA vaccines. Vaccination gives you good immunity to just one viral protein, whereas natural immunity will leave you with antibodies to several proteins. And natural immunity will also wane, as does vaccine-induced immunity. This is pretty standard for coronaviruses, though the nastier ones seem to induce longer-lasting immunity than the benign common cold infections.
    I've seen speculation among immunologists that a natural infection followed by later vaccination may be a good combination to induce good quality immunity (so hooray for me), and also that vaccination followed by recurrent breakthrough infection might be a good thing in the long term, so that the disease achieves seasonal endemicity causing mild symptoms in the vaccinated population. But we've a long way to go before we see good data on that sort of long-term result, and of course the introduction of booster doses by some countries is going to complicate things.

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    Quote Originally Posted by borman View Post
    A possibly important issue not raised is whether vaccinated individuals who are unlucky to get a breakthrough infection can also suffer from other long-COVID19 symptoms as equal to not vaccinated people. The initial reports as far as the main symptoms is that breakthroughs are not as severe for the vaccinated. Is there data regarding the long-COVID symptoms for breakthrough cases?
    Very little so far, because this is all still new stuff.
    There was a study of breakthrough infections from Israel published in the NEJM last month, which demonstrates that people can get Long Covid from a breakthrough infection, but that wasn't the primary outcome measure of the study, and the numbers are very small, so we can't say much about the epidemiology at present beyond "it certainly can happen".

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    Thanks for the link. Small sample of 39 breakthoughs, but 19% long-covids from that sample still seems significant. What % of unvaccinated also get long-covid? While vaccines protect from fatal illness, do they offer any better protection from long-covid than no vaccination?

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    Quote Originally Posted by borman View Post
    Thanks for the link. Small sample of 39 breakthoughs, but 19% long-covids from that sample still seems significant. What % of unvaccinated also get long-covid? While vaccines protect from fatal illness, do they offer any better protection from long-covid than no vaccination?
    I think the numbers are so small we can't have much confidence in the exact figure from Israel, beyond being a demonstration that it does occur relatively commonly. The prevalence of Long Covid in the unvaccinated of course depends on your definition of Long Covid, both in terms of symptoms and duration. REACT-2 is churning out all sorts of Covid data in the UK, and they looked at Long Covid recently.
    37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more.
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  12. #2772
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    Good news everyone

    Had COVID? Youíll probably make antibodies for a lifetime


    https://www.nature.com/articles/d41586-021-01442-9

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    There is a document circulating at present which purports to be from the Japanese journal of antibiotics, March 2021.
    The title is "Global trends in clinical studies of ivermectin in COVID-19"
    Authors are
    Morimasa Yagisawa, Ph.D.1,2 , Patrick J. Foster, 2 ,
    Hideaki Hanaki, Ph.D.1 and Satoshi Ōmura, Ph.D.1

    1 Kitasato University Ōmura Satoshi Memorial Institute
    2 Keio University Faculty of Pharmacy

    (Received for publication March 10, 2021)

    I've tried to understand what they are claiming but a large proportion of the document appears to be a general history or time line of the Covid-19 epidemic. As per the title, they are pushing Ivermectin as a valid therapeutic for Covid-19.

    The first thing that I noticed was that the invitro trials they mentioned were actually using a concentration of ivermectin far higher than the usual human doses. Then there is added political slant and repetition of covid-19 history.

    I go to around halfway through the 90 page document but was speed reading after the first 10 pages or so.

    If anyone else would be interested it's available here. (pdf, 1 MB)

    Edited to add, the people circulating this are calling it definitive proof that ivermectin works and is being suppressed due to... [conspiracy woo]

  14. #2774
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    Iíll take a look at least. One thing to note is that the last author received the Nobel Prize for the discovery of ivermectin, not not necessarily the most objective person to judge it. If itís not based on clinical trials, in any case, itís not very significant.


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    As above, so below

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    Be aware that this article was published in March, and so predates the withdrawal of a key early paper over concerns of plagiarism and data manipulation. The withdrawn paper purported to demonstrate a massive (some might say therapeutically unlikely) effect from ivermectin, and had a disproportionate skewing effect on any meta-analyses that included it.
    The recent review from the highly regarded Cochrane collaboration concluded:
    Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19. The completed studies are small and few are considered high quality. Several studies are underway that may produce clearer answers in review updates. Overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials
    Science Media Centre responses are here.

    As usual, the conspiracy theory is largely driven by people who don't appreciate the complexity of the medical literature.

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  16. #2776
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    Quote Originally Posted by grant hutchison View Post
    Be aware that this article was published in March, and so predates the withdrawal of a key early paper over concerns of plagiarism and data manipulation. The withdrawn paper purported to demonstrate a massive (some might say therapeutically unlikely) effect from ivermectin, and had a disproportionate skewing effect on any meta-analyses that included it.
    The recent review from the highly regarded Cochrane collaboration concluded:Science Media Centre responses are here.
    Thanks for the link. I started reading it yesterday, and the impression I got is that it seemed a well written article and I would have been interested in reading more. But as Grant mentioned, it's kind of old now, and some of the studies have been retracted, so I'd like to see an updated article.
    As above, so below

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    Quote Originally Posted by Jens View Post
    Thanks for the link. I started reading it yesterday, and the impression I got is that it seemed a well written article and I would have been interested in reading more. But as Grant mentioned, it's kind of old now, and some of the studies have been retracted, so I'd like to see an updated article.
    It's one of the weirdest papers I've ever read--rambling and unfocussed, and quite unlike a normal review article. Difficult to see how it made it into print in its current form.

    Yagisawa (along with a new bunch of co-authors) has just had another review published in another obscure journal, with a ridiculously grandiose title that all alone is enough to set alarm bells ringing: Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19.
    Unfortunately, they continue to reference the retracted Egyptian paper, among other failings. David Gorski completely (and entertainingly) dismantles it at Science-Based Medicine. It's a long read, but if you have the time and interest in the issues, I recommend it.

    If you want good quality meta-analysis from a reputable source, keep an eye out for updates of the Cochrane review I linked to previously.

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    Quote Originally Posted by grant hutchison View Post
    It's one of the weirdest papers I've ever read--rambling and unfocussed, and quite unlike a normal review article. Difficult to see how it made it into print in its current form.

    Yagisawa (along with a new bunch of co-authors) has just had another review published in another obscure journal, with a ridiculously grandiose title that all alone is enough to set alarm bells ringing: Ivermectin: a multifaceted drug of Nobel prize-honoured distinction with indicated efficacy against a new global scourge, COVID-19.
    Unfortunately, they continue to reference the retracted Egyptian paper, among other failings. David Gorski completely (and entertainingly) dismantles it at Science-Based Medicine. It's a long read, but if you have the time and interest in the issues, I recommend it.

    If you want good quality meta-analysis from a reputable source, keep an eye out for updates of the Cochrane review I linked to previously.

    Grant Hutchison
    Thanks for the links. I agree, "rambling" describes that article perfectly. I think that's what set off the alarm bells.

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    Quote Originally Posted by grant hutchison View Post
    It's one of the weirdest papers I've ever read--rambling and unfocussed, and quite unlike a normal review article. Difficult to see how it made it into print in its current form.
    I'm sorry, I might be too used to reading papers written by Japanese authors. Unfortunately, the publishing world is a bit different here. Where in the West, editors tend to be very aggressive in their editing, Japanese editors tend to be quite hesitant to suggest major changes to papers published by professors, out of the typical deference to authority that is so common. To me as a Westerner, the idea that a person can write well just because they are a researcher doesn't make a lot of sense, but the tendency definitely exists. I should have probably said that the paper didn't seem to me as a propaganda piece though it doesn't seem entirely dispassionate either. I'll look at the Cochrane review paper, as I am sure it is much higher quality.
    As above, so below

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    Quote Originally Posted by Jens View Post
    I'm sorry, I might be too used to reading papers written by Japanese authors. Unfortunately, the publishing world is a bit different here. Where in the West, editors tend to be very aggressive in their editing, Japanese editors tend to be quite hesitant to suggest major changes to papers published by professors, out of the typical deference to authority that is so common. To me as a Westerner, the idea that a person can write well just because they are a researcher doesn't make a lot of sense, but the tendency definitely exists. I should have probably said that the paper didn't seem to me as a propaganda piece though it doesn't seem entirely dispassionate either. I'll look at the Cochrane review paper, as I am sure it is much higher quality.
    To that we can add that the Japanese Journal of Antibiotics has an impact factor indistinguishable from zero, and has been dumped from Scopus indexing. In terms of academic research publication, that makes it a close approximation to the bottom of the barrel--I know academics in the UK who would consider that having a publication in such a journal is actually slightly worse than having no publication at all. Basically, if your paper is published in such a journal, it generally indicates that it has been knocked back by a series of more prestigious journals.

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    As many of you may recall, I pushed hard for masks based off of the disease being respiratory, correlation to countries using masks, and precautionary reasons. All I got was grief. I also posited in January or February of 2020, on this thread, that disease was too good. A few times on this forum i said gain of function was too dangerous prior to any of this happening. Now I ask, are the dominoes starting to fall on the origins theories. Lancet changes tune. https://www.thelancet.com/journals/l...019-5/fulltext
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    Oddly, I recall being the sole voice crying in the wilderness at that time, pointing out that the purported evidence for the use of face-coverings was flimsy, contradictory and misapplied at best, and downright wrong at worst, and getting nothing but grief for it.
    At the time, I said we'd probably have decent evidence in a year, provided face-covering didn't become "gold plated" into public health policy in the meantime. Turns out I was wrong--it took closer to eighteen months. The DANMASK-19 trial in Denmark unfortunately turned out to be ludicrously underpowered, based on an unrealistic estimate of the protective power of face coverings.
    But a few weeks ago we got a pre-print of The Impact of Community Masking on COVID-19: A Cluster-Randomized Trial in Bangladesh, which looked at symptomatic seroprevalence as its primary outcome. It appears to be well-conducted and recruited the massive numbers necessary. There was a modest reduction in the prevalence of symptomatic Covid in communities who underwent the "mask" intervention (9%), with surgical masks more effective than cloth masks (11% versus 5%). It also demonstrates the complexity of the intervention necessary to achieve that effect, with health-care workers actually visiting the relevant areas and issuing reminders in public places.
    It still needs peer review, and we can argue about the transferability of data from rural Bangladesh to (say) the London Underground during the rush hour, about the likely effect on asymptomatic Delta-variant Covid, and about the authors' definitions of a surgical vs. cloth mask, but we finally seem to be getting somewhere with the science.

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    Quote Originally Posted by Copernicus View Post
    As many of you may recall, I pushed hard for masks based off of the disease being respiratory, correlation to countries using masks, and precautionary reasons. All I got was grief. I also posited in January or February of 2020, on this thread, that disease was too good. A few times on this forum i said gain of function was too dangerous prior to any of this happening. Now I ask, are the dominoes starting to fall on the origins theories. Lancet changes tune. https://www.thelancet.com/journals/l...019-5/fulltext
    So, what, you are saying that we should trust your intuition rather than published scientific studies and well thought out trials? I'm pretty sure that kind of reasoning is why people are currently overdosing on horse dewormer and topical disinfectants.

    Public health initiaives need to be science led if they are to retain the faith of the populace and stand up to scrutiny. As it is masks became a thing probably because of the precautionary princple and the need to be seen to be doing something. I don't know, I haven't followed the ins and outs of the debate on them.

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    The Precautionary Principle was frequently cited by those who pushed for mask mandates on the basis of mechanistic arguments (but it's a barrier!) and cum hoc reasoning (but we're seeing lower prevalence in countries that already use face coverings!). It was actually a rather odd deployment of the PP, which in public health generally revolves around not doing something until you're sure it won't do more harm than good.
    The clinical evidence for benefits of community masking largely came from experience with flu, and weren't particularly impressive. And at that time there were significant valid questions being raised of potential harm, both in terms of "risk compensation" behaviour (mask wearers neglecting appropriate distancing), and that inexpert handling of contaminated masks might put more people at risk from surface contamination than it saved from direct droplet spray. For an insight into the debate as it stood in April 2020, take a look at expert discussion from that date at the Centre For Evidence-Based Medicine and at the Science Media Centre. It was very far from being a clear picture.

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    Quote Originally Posted by Copernicus View Post
    As many of you may recall, I pushed hard for masks based off of the disease being respiratory, correlation to countries using masks, and precautionary reasons. All I got was grief.
    I'm kind of surprised at that. I was never against masks (in fact, I think I often posted that in Japan, people don't find it unnatural and I feel safer that way). I do remember a conversation where someone suggested that masking might encourage people to take more risks (like not keep distance), but I pointed out that it can be just the opposite, in the sense that wearing a mask is a signal that we want to maintain distance. And in addition, I'm not sure what you mean when you say you "pushed hard for masks." Do you mean in your community? If you pushed for masks in your community, I'm not sure why I would remember that. If you mean you pushed for people on this site to wear masks, this is a virtual forum so how would I even know if other people are wearing masks. And in any case, you can't infected through the Internet (most of us have antivirus software).

    ETA: I do remember Grant arguing that masks might not be effective, but I never saw that as "grief" but rather giving me information based on science at the time, in a quest that we should all be interested in to understand how to deal with the pandemic.
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    Quote Originally Posted by Jens View Post
    I do remember a conversation where someone suggested that masking might encourage people to take more risks (like not keep distance), but I pointed out that it can be just the opposite, in the sense that wearing a mask is a signal that we want to maintain distance.
    I think we may have had that conversation. The idea that "risk compensation" might occur in response to mask mandates was an early concern, largely dismissed by pro-masking campaigners, who cited both experience from cultures which regularly wear masks (as in east Asia) and data from other safety interventions (like bicycle helmets) which did not lead to demonstrable risk compensation. That reasoning wasn't entirely satisfactory, however, because (as you're aware) the function of facemasks in eastern society has evolved to embed a degree of social signalling in a way that hasn't happened in the West, and because the bicycle helmet thing was evidence that risk compensation need not necessarily occur, rather than proof it would not occur. (Indeed, skydivers have long quoted Booth's Rule #2: "The safer skydiving gear becomes, the more chances skydivers will take, in order to keep the fatality rate constant.")

    We now actually have a little bit of evidence that mask mandates did indeed lead to a degree of risk compensation in the USA:
    We find that face mask orders lead to risk compensation behavior. Americans subject to the mask orders spend 11–24 fewer minutes at home on average and increase visits to some commercial locations—most notably restaurants, which are a high-risk location.
    And given the relatively small apparent benefit from mask usage, it wouldn't take a lot of risk-compensation behaviour to undo the mask's effectiveness.

    The same concern is now being expressed over the behaviour of vaccinated people. Watch this space for the unintended consequences of governments deploying "vaccine passports" to allow their citizens to attend mass gatherings.

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    Quote Originally Posted by Jens View Post
    ETA: I do remember Grant arguing that masks might not be effective, but I never saw that as "grief" but rather giving me information based on science at the time, in a quest that we should all be interested in to understand how to deal with the pandemic.
    Having been peripherally involved in some research into the usefulness of surgical facemasks for infection control in operating theatres (not very useful), I was very concerned about the hype being peddled with regard to face coverings early in the pandemic. We were essentially being told that, if everyone wore a mask, the pandemic would be over. As a recipe to encourage risk-compensatory behaviour, that sort of messaging really couldn't be bettered.

    And a few months later, if demonstration were needed, we saw Israel achieve the highest case rate in the world while trying to ease out of its first lockdown, despite it being a legal requirement for all Israelis to wear face coverings when outside their homes.

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    Quote Originally Posted by Shaula View Post
    So, what, you are saying that we should trust your intuition rather than published scientific studies and well thought out trials? I'm pretty sure that kind of reasoning is why people are currently overdosing on horse dewormer and topical disinfectants.

    Public health initiaives need to be science led if they are to retain the faith of the populace and stand up to scrutiny. As it is masks became a thing probably because of the precautionary princple and the need to be seen to be doing something. I don't know, I haven't followed the ins and outs of the debate on them.
    I have no opinion of ivermectin or quinine. I do have concerns about what is science. Science or medical treatment, seems to be strongly connected to advertising, efficacy, and political connections. Their are different theories of improvement of treatment. It used to be doctors could use medications for off label. This is not true, to any great extent, for covid. It is very rigid. Another science would allow an evolution of treatment based off of off label treatments. Successes would be replicated. Double blind gold standard proof would be later phenomena. Other than lots of supportive oxygen, proning, steroids, and blood thinners, I don't see much that helps people live through this disease once they have the disease. Only lots of supportive oxygen actually gives these people much of a chance of survival. It is not pretty out there working on a Covid floor. Remdesivir and plasma from infected people seems to be a flop. Bipap's help, but a lot of people are very resistant to this treatment, then they die or get intubated, and that doesn't have much success either. Still grim. I think the disease is airborne now and masks and close distancing don't help much any more. Many more unvaccinated people are in the hospital than unvaccinated. At least 10 to 1, perhaps 20 to 1. The vaccinated ones tend to be very old most of the time.
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    Off-label treatments are not science--they're uncontrolled experimentation, and therefore lie on the dubious margins of medical ethics. We've been around and around the houses, over the years, with supposedly wonderful treatments that turned out to be useless or harmful once subjected to proper investigation.
    The only way to do proper science with off-label treatments is to enrol every patient thus treated into a clinical trial--something which drug regulatory bodies have been active in recommending throughout the Covid pandemic. For example, the supposedly "suppressed" wonder-drug ivermectin is currently the subject of 78 clinical trials registered at ClinicalTrials.gov. So there's no barrier to doctors using drugs off-label--they just need to be sure they're involved in a well-designed data-gathering exercise.

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    Quote Originally Posted by Copernicus View Post
    ……. Many more unvaccinated people are in the hospital than unvaccinated. At least 10 to 1, perhaps 20 to 1. The vaccinated ones tend to be very old most of the time.
    A while ago the CDC said 29 to 1. That is as high as you could expect given the vulnerable vaccinated population.
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